What happened, in summary

A 66-year-old woman underwent colonoscopy because of intermittent rectal bleeding and was found to have a low rectal mass. Biopsy showed moderately differentiated adenocarcinoma. CT and MRI showed a locally advanced low rectal lesion about 6 cm above the dentate line with mesorectal lymphadenopathy.

She received neoadjuvant chemotherapy and radiotherapy, then underwent laparoscopic hand-assisted low anterior resection with total mesorectal excision. A colonic J-pouch was created and joined to the rectal stump about 1 cm above the dentate line, with a protective diverting loop ileostomy. She recovered well and went home after 5 days.

Five weeks later, she developed purulent vaginal discharge. Examination showed a small opening in the posterior vaginal fornix. At surgery 3 months after the original operation, a fistula was found between the upper staple line of the J-pouch and the posterior vaginal wall. The pouch and colorectal anastomosis were removed, the vaginal defect was repaired, and a straight coloanal anastomosis was created with an omental flap placed between the colon and vagina.

She was discharged 4 days later without postoperative complications. Three months after the repair, imaging showed normal passage through the distal colon and the loop ileostomy was successfully closed. She remained fully continent, although she experienced about 5–10 liquid bowel movements each day.